1. Student ID: (You may leave this blank if not known.)
2. First Name: 3. Last Name:
4. Date of Birth: 5. Grade in Sept. : K 1 2 3 4 5 6
6. Student's primary language:
7. NMUSD School of Residence: N/A Private School Non-NMUSD School Private Pre-School NMUSD Pre-School Adams Andersen Back Bay HS California Cloud Campus College Park (Mandarin) College Park Corona del Mar HS Corona del Mar MS Costa Mesa MS Costa Mesa HS Davis Early College HS Eastbluff Ensign Estancia HS Harbor View Kaiser 3-6 Killybrooke Lincoln Mariners Newport Newport Coast Newport Harbor HS Newport Heights Paularino Pomona Rea Sonora TeWinkle Victoria Whittier Wilson Woodland TK-2 Whittier (Dual Immersion)
8. Has the child attended a Spanish Dual Immersion program previously?Yes No If so, list name of school:
9. Does the Spanish Dual Immersion applicant have siblings applying for school choice to attend the traditional program at this school? YesNo
10. Address:
11. City: 12. Zip:
13. First Name: 14. Last Name:
15. Daytime Phone Number: 16. Alternate Phone Number:
17. Email Address: 18. Re-type Email Address:
Please enter Parent/Guardian's Legal Name as the signature: